Kicksite Student Reimbursement Claim

If your bank applied overdraft or NSF fees to your account due to duplicate pending Kicksite charges on Tuesday, 4/25, fill out this form to request reimbursement for these fees.

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

School Name(Required)

Total requested reimbursement amount:(Required)

Amount listed should match the fee amount shown in your bank statement or transactions list screenshot(s).

Bank Statement Images(Required)

Please upload a screenshot of your bank statement or transactions list showing the charge from Kicksite as well as the overdraft or NSF fee that was applied to your account. Multiple file uploads are accepted if neccessary.

Drop files here or

Max. file size: 300 MB.